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One of the most common problems that patients encounter and ask us for help for are missing teeth. How to replace missing teeth is the basis of that brach of dentistry known as ‘Prosthodontics’.  This is the branch of dentistry that we specialise in at our practice.

Whenever a patient presents to us asking about what can be done with a gap between their teeth there are usually five options as to what to do with the gap. These are:  1/ Do nothing, 2/ Replace the gap with an implant/implants, 3/Replace the gap with a bridge, 4/Close the gap with braces, or 5/Replace the gap with false teeth (dentures). Options 2/ and 3/ are so-called ‘fixed options’ because they are firmly fixed in the mouth and do not need to be taken out by the patient. Option 5/ is the ‘removable’ option as a denture must be inserted manually and removed at night time and for cleaning purposes.

OPTION 1 – Do NOTHING

If a tooth is at the back of the mouth and not particularly important to you for appearance you may choose not to replace the gap. In several cases the loss of a back tooth does not affect chewing ability either, particularly if there are several other teeth present in the mouth. In fact, it is debateble as to whether we need teeth to eat at all with todays modern diet but this is a subject for a different post! For many people, as long as they have the premolar, canine and incisor teeth present, the loss of a back tooth (molar) will have little significance. This is the basis of a concept known as a ‘shortened dental arch’ and appears to work well the older one gets. When the tooth/teeth missing are at the front of the mouth, appearance becomes a larger issue and other options are then considered.

OPTION 2 – REPLACE THE GAP WITH A DENTAL IMPLANT/IMPLANTS

These days a common way to replace teeth  is with implants. This is relatively straightforward now. An implant is a titanium fixture (like a parallell sided screw) that is inserted in the bone under the gum. This fixture integrates with the underlying bone to become solidly fused. The integration with the bone takes a few months. After this, a crown that gets fixed to the top of the implant is attached to replace the missing tooth. For an implant to be possible there must be a sufficient amount of bone available to place the implant into. The advantage of implants apart apart from their being fixed are that they give good chewing ability and no other teeth need be modified/pared down to place one.

OPTION 3 – RPLACE THE GAP WITH A BRIDGE

Bridges are false teeth that are attached to the teeth either side of the gap. They can span to replace a single tooth or several teeth.  There a two types of bridge: so-called ‘conventional (fixed – fixed) bridges’ and ‘adhesive bridges’. Conventional bridges are made by paring down the teeth either side of the gap and making a mould of the prepared teeth. The laboratory then makes the porcelain bridge unit that fits over the prepared teeth. This is cemented onto the teeth with a special dental cement. The other type of bridge is an adhesive bridge. This is more succesful at the front of the mouth if a single tooth is missing. These type of bridges consist of a metal ‘wing’ with the false porcelain tooth attached to it. The metal wing is then bonded to the back of the tooth next to the gap with a special adhesive cement. The advantage of this bridge over the conventional bridge is that it is more conservative. In other words, the tooth that the bridge is bonded to needs little, if any, preparation done to it (so it is not pared down).

OPTION 4 – CLOSE THE GAP WITH BRACES

This option is an easy one to forget but can be beneficial at times. This option works well if the gap to be closed is relatively small. It is often combined with with crowning or bridging later on, but not always. The braces don’t have to be on for a long period often and is suitable for all age groups. The great advantage of using this option, if possible, is that no teeth need to be prepared, so none are weakened by the process.

OPTION 5 – REPLACE THE GAP WITH FALSE TEET – DENTURES

This is the option that many people dislike as it is the ‘removable’ option. Dentures (false teeth) are made by the laboratory technician after a series of moulds are made of the teeth. They are inserted in the mouth to replace the missing teeth. However, as they are not fixed, they can move in the mouth and indeed, must be removed at night time and for cleaning them. There are two types of denture – acrylic and cobalt-chromium (metal based). The acrylic dentures are the commonly known ‘plastic’ type. They are more succesful when replacing upper teeth. Acrylic dentures utalise the soft tissues (gums) for their support, which makes them move more. Also, all the force from chewing is tranmitted through the gums and this leads to the bone underneath resorbing away relativel quicker over time. The palate provides a broad area of support for these types of denture, which is why they work better when replacing upper teeth. The other type of denture is the cobalt chromium denture. This a denture which has its base made of metal. They utalise the teeth for their support and, hence, do not move in the mouth as much as acrylic dentures. In fact, they usually feel very firm indeed. Because the forces of bite go though the teeth instead of the gum, then bone under the gum does not resorb away as fast as that under an acrylic denture. The teeth form the ideal support mechanism for these dentures. These dentures can often be made smaller than their acrylic counterparts which helps in their toleration. Also they attract less plaque than acrylic dentures and so are healthier for the mouth and remaining teeth. These dentures perform well when replacing both lower and upper teeth.

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This entry was posted on Sunday, April 5th, 2009 at 7:44 am and is filed under Clinical items. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.